Overcoming Anxiety: How Therapy Can Help
Since the beginning of the pandemic, mental health has been in the news on an almost daily basis. The number of Americans reporting symptoms of depression and anxiety has soared, leading many commentators to declare that the country is in the midst of a mental health crisis. In the face of this growing concern, a panel of medical experts recommended that primary care physicians screen their patients routinely for anxiety.
The past few years have brought challenges and stress from a variety of sources: economic hardship, political turmoil, ongoing systemic racism, to name only a few. Added to these are the many losses Americans have faced due to COVID. Very few people have managed to emerge from this period without some emotional strain.
What exactly is anxiety, anyway?
Most people experience mild anxiety at some point in their lives. In fact, anxiety within limits is essential to functioning. Anxiety is nature’s way of keeping us safe - and alive. Humans and other mammals have complex nervous systems that are designed to be vigilant for danger. When a threat is detected, the equivalent of a smoke detector in our brains gets activated, signaling our bodies to either fight or flee.
These biological systems came about millenia ago when humans were threatened by deadly predators. Even though we no longer face this sort of threat, our brains continue to scan for danger - and often misinterpret things as being more dangerous than they are.
For example, our brains might react to something such as public speaking or a major exam as threatening to our well-being. The “fight or flight” response gets triggered, causing a host of physiological reactions, such as elevated heart rate, sweating, etc. It’s important to note that this happens completely outside of our conscious awareness. We do not make this evaluation consciously; that sort of processing would take far too long to ensure our survival.
In many ways, this process of scanning for and reacting to danger continues to be crucial. It is what accounts for slamming on the breaks when a car swerves into our lane, to give just one example. And mild anxiety can even be motivating. Just think: if we never got anxious before a test, we might not be motivated to study.
When anxiety becomes a problem
Although we all need a basic level of anxiety to function in the world, there is a threshold beyond which it hinders us more than it helps. Generally speaking, this is when our nervous systems perceive danger in places (or in people) that are not truly threats. That is not to say that fear of things like social situations or a job interview should be dismissed outright; it means that they are not the life and death situations our brains are registering them as.
When we begin to over perceive danger, it can get in the way of our daily living. When we’re always on the lookout for something that can go wrong, there can be a tendency to avoid the people, places, or situations that feel particularly risky. This can interfere with school, jobs, relationships - and cause one’s life to become smaller and smaller.
Signs that you might have anxiety disorder
The line between normal anxiety and an anxiety disorder may seem blurry. Again, stress and worry can be a part of life that everyone experiences at one time or another. You may, however, want to consider getting anxiety treatment if any of the following applies to you:
You worry so much about the future that it’s hard to stay present
You avoid socializing or making new friends
You feel constantly on edge, even without knowing why
You believe that others are always judging you and you can never make a mistake
You feel paralyzed when having to make a decision or try something new
You experience physical symptoms, such as fatigue, stomach problems, and muscle tension
You can’t sleep because you can’t turn your brain off
What are the different kinds of Anxiety Disorders?
Anxiety disorder is an umbrella term that encompasses a number of distinct disorders, each with their own set of symptoms. They include:
Generalized Anxiety Disorder
This is often what we think about when we hear about anxiety. Generalized Anxiety Disorder is a persistent and excessive worry, out of proportion to the situation. People with GAD tend to worry about a wide range of issues, rather than about a single situation. This disorder makes it difficult to relax; the anxious thoughts seem never ending.
Panic Disorder
An individual is diagnosed with panic disorder when they have recurrent panic attacks. Panic attacks are unexpected periods of fear, discomfort, or a sense of losing control, often with no identifiable trigger. The physical symptoms can include a racing heart, chest pain, and sweating, which make panic attacks easily confused with heart attacks. Commonly, a person who has had a panic attack becomes so fearful of having another that they avoid places where they have occurred.
Social Anxiety Disorder
This disorder refers to intense anxiety around social situations and interpersonal interactions. People with this disorder believe that they are frequently being scrutinized or judged. Situations in which they feel exposed, such as meeting new people, public speaking, or job interviews, can be particularly anxiety producing. They fear embarrassment or rejection, which often leads to an avoidance of uncomfortable situations.
Specific Phobias
Phobias, unlike Generalized Anxiety or Panic Disorder, have very specific triggers. With these, the individual experiences intense fear of a certain activity, situation, or object. Common phobias include fear of flying, fear of heights, or fear of dogs. Phobias can lead people to go to great lengths to avoid what they fear - e.g., taking a cross country train rather than a flight.
How Can Therapy Help?
If you suspect that you may have an anxiety disorder, the thought of seeking help can be daunting. In starting to research anxiety treatment, it’s easy to become overwhelmed by the many types of therapy that are out there.
Cognitive Behavioral Therapy (CBT) is the approach most frequently cited in discussions of anxiety treatment as the “gold standard.” CBT is based on the belief that what we think shapes our emotions. It argues that anxiety (as well as depression) is caused by negative thoughts and beliefs that are in some way distorted; these types of thoughts are called “cognitive distortions.” There are several types of cognitive distortions; a common one is catastrophizing. Catastrophizing is when we assume that the worst case scenario is guaranteed to occur. For example. For example, if you get a less than stellar performance review at work, you may think that you may lose your job, which triggers anxiety. Other cognitive distortions (and examples of each) include:
All or nothing thinking: this is the tendency to see things in black and white terms. “I’m a bad student because I got one C this semester.”
Personalization: taking things personally that have nothing to do with you. “Bill hasn’t responded to my email. He must be angry at me.”
Filtering: focusing exclusively on the negative while discounting the positive, such as thinking. “My performance evaluation was horrible!” when there was one criticism and significant praise.
Overgeneralizations: these are thoughts that include “always” or “never,” as in “I never have anything to do on Friday nights.”
Emotional Reasoning: this is the belief that “if I feel this way, it must be true.” Feelings are mistaken for reality. For example, “I’m feeling lonely, so that means that I’m unlovable.”
CBT treats anxiety by helping you recognize when your thinking is distorted and ways that you can replace your thoughts with more accurate ones. For instance, rather than taking it as a given that someone is upset with you when they haven’t called you back, CBT teaches you to take a step back and consider other possible explanations.
CBT teaches a range of techniques that allow you to manage your anxiety outside of session, such as journaling/thought records, thought stopping, and progressive relaxation. Exposure therapy, a subset of CBT, is sometimes used with specific phobias to gradually help reduce a client’s avoidance of feared situations.
A Holistic Approach to Anxiety
Of the many kinds of therapy, CBT is the one that has been the most researched. This is because, in part, it follows a straightforward protocol that makes it ideal for research studies. The same treatment can be replicated over and over with little variation. Other modalities tend to be less studied because they tend to be tailored to the individual client, creating many variables that can be impossible to control.
Given the challenges in comparing the different types of therapy, we can’t truly know which modality is most effective for treating anxiety. CBT undoubtedly offers valuable tools and has helped many people. However, I would argue that this does not mean that it is without its limitations - or that other kinds of therapy are not also effective. In my experience, there are other elements important to effective anxiety treatment which CBT alone may not necessarily incorporate. These include:
A strong therapeutic alliance. Research has shown that this is the most important ingredient in therapy for any mental health condition. The quality of the relationship between therapist and client determines the effectiveness of the therapy more than the modality. A strong alliance allows the client to feel safe and understood, which likely increases their motivation and engagement. Most therapists who practice CBT work to cultivate a connection with their clients; however, a focus on manualized treatment may detract from this in some cases.
Understanding how the past influences the present. CBT targets the thoughts that are occurring in the here and now. It does not delve into the origins of distorted thoughts to understand how they developed. In my experience, having an awareness of why you hold certain negative beliefs can be very valuable. Understanding the factors that have shaped your mindset can help you rewrite your narrative overall, rather than only addressing each individual thought. Additionally, understanding how your history influences your present-day thinking can go a long way in counteracting shame and self-blame.
Integrating the mind-body connection. Recent advances in psychology have highlighted the importance of bringing attention to the body in anxiety treatment. Our minds and bodies are deeply connected and influencing each other constantly. As we discussed above, anxiety originates in our nervous systems and its impacts are felt physically. In targeting negative thinking, CBT focuses only on mental processes and leaves out what is going on from the neck down. Newer modalities such as mindfulness and Sensorimotor Psychotherapy provide ways for a therapist to address anxiety in a more holistic manner.
In my practice, I believe that all of these elements are essential to helping clients overcome their anxiety. CBT serves as a valuable set of tools for clients, but I integrate it into a context that places priority on the relationship, in-depth exploration of the client’s history, as well as the importance of the body. Each individual brings their own particular needs to therapy, so I believe in using a framework that allows for flexibility and creativity. One size does not fit all when it comes to anxiety treatment.
Ready to Begin Anxiety Treatment in Silver Spring, MD?
If you’re ready to take back your life from anxiety, I’d be honored to work with you to help you reclaim your life. You don’t have to do this alone.
Learn more about therapy with me and the cost of sessions at my Washington, DC area therapy practice. Then, let’s set up a free 15-minute consultation call where I can answer all your questions and we can get started on your healing journey.
Other Services at Lisa Zimmerman Therapy
As an experienced anxiety therapist, I know that anxiety isn’t usually the only thing that you are struggling with. This is why I also offer therapy for codependency, trauma therapy, and more. Let’s get started working through your struggles so you can live your life fully.